Cost of Tuberculosis to Patients and Their Family in Adama Town, Oromia, Ethiopia: A facility based study

Abstract

Background: Tuberculosis is a global health problem. Worldwide in low- and middle income countries the total funding for tuberculosis prevention, diagnostic and treatment reached US$6.9 billion in 2018, an increase from US$6.2 billion in 2017 and the median cost per patient treated in 2017 was US$ 1224 for drug-susceptible tuberculosis and US$ 7141 for drug resistance tuberculosis. Previous studies conducted in Ethiopia were addressing only patients side cost and included only public health facilities. This study includes companion side costs and private health facilities cost of TB patient. Objective: This study is aimed to determine cost of tuberculosis to patients and their family in Adama town, Ethiopia. Methods: Facility based cross-sectional study design was employed and cost of illness study on 229 tuberculosis cases at health facilities in Adama town was conducted using interveiwer administered semi-structured questionnaire. A systematic random sampling technique was employed to select study participants. We employed a micro-costing bottom–up approach in order to estimate direct cost of tuberculosis. Indirect costs for the study participants and their accompanyins persons were calculated interms of productive time losses, using human capital approach. The data cleaning and entry was undertaken using Epi data 3.1 and analyze using SPSS-20 statistical software, and result was presented using descriptive statistics like, frequency, percentage, mean, standared divetion, median and intr-quartertile range. The Ethical approval was obtained from the Institutional Review board of the Jimma University, legal letters from respected organization and oral informed consent from study participants. Result: A total 229 TB patients were interviewed, 45.4% were smear-positive pulmonary TB, 28.4% smear-negative pulmonary TB, 24.9% Extra-pulmonary TB and 1.3% was multi-drug resistance TB cases. The total mean direct cost of TB patient was ETB 5784.01 (USD 210.54) with SD 4019.12 (USD 146.30). Of direct costs, direct non-medical cost accounted 73.5% of the total mean direct costs of TB patients. The total mean indirect cost was ETB 5481.61 (USD 199.53) with SD of ETB 6588.48 (USD 239.82). The total mean and median cost of TB illness to patient and accompanyins were ETB 11265.62 (USD 410.08) with SD of ETB 9286.68 (338.05) and ETB 8870.0 (USD 322.88) with IQR of ETB(6097.50,14140), respectively. Conclusion: Tuberculosis patients incur substantial cost for care seeking and treatment despite the availability of free of charge anti-TB drug. Direct non-medical costs and indirect costs were high cost on tuberculosis patients.